Healthcare Provider Details

I. General information

NPI: 1497731996
Provider Name (Legal Business Name): JEFFREY J RITSEMA OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 EAST PARIS AVE SE
GRAND RAPIDS MI
49546
US

IV. Provider business mailing address

2112 EAST PARIS AVE SE
GRAND RAPIDS MI
49546
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-8500
  • Fax: 616-949-2878
Mailing address:
  • Phone: 616-949-8500
  • Fax: 616-949-2878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901002377
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: